Focus Shoulder Specialists

We don’t realise how important our shoulder is until we can’t use it!

This means understanding your shoulder and effective treatment play a role in a successful recovery

Nobody plans to have an acute or chronic a shoulder injury, but given how much we use our shoulders, it’s surprising how well they hold up.
The shoulder joint is prone to injury because it is very mobile. This mobility – allowing frequent overhead movement and exposure to sudden trauma – can result in tissue damage inside the shoulder.

The result?

It can lead to fractures, arthritis, rotator cuff tendon injuries, bursitis and stiffness. With pain, tenderness, weakness, instability, and limited movement in the shoulder joint.
There are many treatments available to patients, depending on their specific condition. Dr Dan’s specialty is in the management of complex shoulder disorders, arthroscopic shoulder reconstruction and joint replacement for arthritis using a combination of surgical and non surgical treatment.

I want to discuss my treatment options with Dr Dan

Shoulder conditions vary and so do the solutions

The shoulder is a complex of joints that includes four key joints:

Glenohumeral joint or ball-in-socket
Acromioclavicular joint, commonly referred to as collar bone attachment to the acromion of the scapula
Scapulothoracic joint, known as the wing bone moving on the thorax or chest
Sternoclavicular joint, which is the collar bone attachment to the breast bone.

We don’t expect you to know everything about the shoulder – but it will be helpful for your recovery to understand how they work together and where your specific condition fits in.

Certain conditions are associated with different parts of the shoulder. While not comprehensive, the following table provides a high level summary of the conditions and disorders associated with the shoulder and the typical treatment pathway.

Common Conditions

The below is a summary guide only

More detailed information specific to your condition is given in your consultation with Dr Dan, who will also provide additional resources to supplement your discussion

Condition

The AC joint is on the top of the shoulder and connects the clavicle (collarbone) to the acromion which is a part of the scapula (shoulder blade).

What happens

Normally cartilage caps the end of both bones. This joint is prone to dislocation through a traumatic event such as a fall onto the shoulder or repetitive overhead motions. In the older population arthritis, or loss of cartilage occurs. As this degenerates there may be a loss of the cushioning effect leading to pain.

Treatment options

Non-surgical

Rest, modifying activities, taking anti-inflammatory medication, hot/cold applications, supervised physical therapy, cortisone injections.

Surgical

After dislocation this joint can be reconstructed. When arthritis develops arthroscopy or open shoulder surgery is an option to make room so there is no irritation from compression of the joint surfaces.

Condition

Sometimes referred to as osteonecrosis, this condition means the bone dies as a result of loss of its blood supply.

What happens

This may be due to trauma, which results from a fracture or other factors. AVN usually presents as pain and may also be associated with noise and a crunching sound.

Treatment options

Non-surgical

Medical therapies by minimising risk factors and in some cases prescribed medications.

Surgical

Arthroscopy if cartilage is damaged and loose pieces in the joint are causing pain. Partial or total shoulder replacement are effective options.

Condition

The bicep is a unique muscle because it attaches to the radius bone across the elbow, as well as through two tendons both to the scapula.

What happens

Biceps problems are common. They usually result from repetitive motion associated with overhead work or a sudden injury with or without a rupture of the adjacent subscapularis tendon. When the injury is a consequence of chronic inflammation, it is called biceps tendonitis.

Treatment options

Non-surgical

Physical therapy and activity modification may help to relieve pain. Avoidance of repetitive reaching and lifting may allow the tendon inflammation to improve. Anti-inflammatory medications may also help reduce pain.

Surgical

Via arthroscopy for refractory cases with marked pain and limited function. In these cases, a tenodesis of the biceps tendon is performed. The tendon is anchored to the bone in a position which prevents it getting inflamed.

Condition

The normal shoulder is surrounded by a bursa. Inflammation of the bursa (bursitis) results in pain with overhead movements.

What happens

The bursa contains small nerve endings which when inflamed cause pain.

Treatment options

Non-surgical

Program of physical therapy, anti-inflammatory and cortisone injection.

Surgical

Arthroscopic keyhole surgery called a bursectomy results in excellent results. The recovery time is short and success rate high.

Condition

A condition that usually affects individuals over the age of forty and is characterized by accumulation of deposits of calcium in the rotator cuff tendons of the shoulder. In simple terms it means Irritation or inflammation of the tendon where the deposits accumulate. This can also be called Bursitis.

What happens

The exact cause is unknown but is thought to occur because of decreased oxygen to the tendon of the rotator cuff as part of the aging process or possibly because of mechanical factors such as pressure on the tendons when the arm is lifted overhead over many years.

Treatment options

Non-surgical

Conservative, non-operative treatment (as calcium deposits generally resorb spontaneously); oral anti-inflammatory medication for pain; possibly physical therapy; and cortisone injections.Ultrasound shock therapy and needling may also be used.

Surgical

Arthroscopy may be used to remove the calcium deposits and the inflamed bursa. This is called a bursectomy.

$Medium Shoulder clavicle fracture$
$Medium Shoulder fracture clavicle plate$

Condition

The clavicle or (collarbone) is the bone that runs along the front of the shoulder to the breast bone (sternum). It is important to the overall mechanics and function of the shoulder.

What happens

Clavicle fractures may be simple mid-shaft fractures that present with pain and bruising. There may also be a deformity or asymmetry of the shoulder due to the movement of the clavicle fracture fragments. A patient may also experience swelling from bleeding (hematoma).

Treatment options

Non-surgical

An evaluation (exam and x-ray) will be conducted in the first instances.Generally fractures that have not separated are termed “undisplaced fractures” and require treatment in a sling only. Fractures that have separated (displaced) require x-ray evaluation and interpretation to determine the best treatment choice for the individual.

Surgical

Generally when the fracture ends do not meet, fixation of the fracture is recommended. Certain professionals and sportspeople involved in overhead activities may benefit from surgery

Condition

Frozen shoulder or (Adhesive capsulitis) is a term used to describe a stiff shoulder. The patient notices loss of motion usually in more than one direction.

What happens

Typically presents as a gradual loss of motion that occurs without trauma.The lining of the shoulder becomes inflamed causing pain and stiffness.

Treatment options

Non-surgical

Rest in combination with a supervised physical therapy program of gentle stretching can assist in regaining motion.

Surgical

Arthroscopic (key-hole) release of capsular tissue lining the joint is effective.

Condition

Also known as a reverse total shoulder arthroplasty.

What happens

In a reverse shoulder replacement, the ball of the shoulder (humeral head) is replaced with a socket, and the socket of the shoulder (glenoid) is replaced with a ball. This is a design feature used in arthritis cases where the rotator cuff is torn or unhealthy.

Treatment options

Surgical

Shoulder replacement in patients who have shoulder arthritis and are without normal rotator cuff muscles and tendons.

Condition

The rotator cuff enables several forms of motion. The rotator cuff may be injured from repetitive overhead motion, a sudden trauma, degenerate with the normal aging process or a combination of all the above. The supraspinatus tendon is the most common tendon torn. Inflammation of the surrounding bursa (Bursitis) often results causing pain with overhead movement.

What happens

Impingement is mechanical compression of the rotator cuff against the acromion bone. This condition may occur with or without the development of a rotator cuff tear. Often a tear results in weakness.

Treatment options

Non-surgical

A program of physical therapy, anti-inflammatory medications, cortisone injections.

Surgical

Rotator cuff repair surgery involves the torn tendon being re-anchored to the bone. This can be performed arthroscopically via keyhole surgery. At the same time the inflamed bursa (bursitis) is removed (bursectomy). Recovery takes 3 months.

Condition

In shoulder arthritis the joint space is narrowed and the humeral head (ball) becomes irregular and flattened. Osteoarthritis of the shoulder is a disease that involves breakdown of the articular cartilage that normally allows the joint to glide smoothly with each other

What happens

Cartilage breakdown may be caused by wear and tear over time. Cartilage does not heal when damaged. Instead, the body tries to heal by making more bone and this results in an irregular joint with extra bone spurs called osteophytes. The result is loss of motion due to irregular joint surfaces. In addition, the inflammation caused by the arthritis results in thickening and scarring of the joint capsule which also contributes to loss of motion.

Treatment options

Non-surgical

Modified activity, e.g. eliminating weight lifting and physical therapy, which may help with flexibility, and use of anti-inflammatory medication. Cortisone injections may also be used to reduce pain.

Surgical

Arthroscopic debridement will help remove some mechanical and chemical irritants in the shoulder in addition to the loose cartilage flaps or loose bodies. Alternatively, full shoulder joint replacement is the long term treatment with best results.

Condition

Shoulder instability occurs when the humeral head (ball) moves out of the glenoid (socket) during shoulder motion. It can occur through a sudden, traumatic event (football tackle or fall) or through repeated movements that stretch the ligaments, causing the ball to move out of the socket partially.

What happens

Symptoms are typically pain and sometimes a sense of shifting. Dislocation is when the ball completely moves out of the socket. Partial movement of the ball out of the socket is called a subluxation.Other associated injuries may occur to the nerves, ligaments, cartilage and labrum in the shoulder called a Bankart tear.

Treatment options

Non-surgical

Sometimes the ball can move back into the socket on its own. If the shoulder remains dislocated, a visit to a hospital emergency room will be required to reduce the shoulder back into place. This is usually done with intravenous sedation (medicine by vein) to muscles relax to allow the gentle manipulation of the arm ball back into the socket.

Surgical

Repair or reconstruction of the damaged ligaments and labrum is undertaken via arthroscopic keyhole surgery.With extensive injuries where the glenoid bone (socket) is damaged an open stabilisation operation is more secure; called a latarjet procedure.

Condition

SLAP is an acronym for superior labrum anterior posterior.

What happens

A SLAP injury may be caused by a sudden or forceful pull on the biceps as with a fall, or lifting a heavy object, or a trauma with a dislocation of the shoulder, can detach the superior labrum through a strong pull of the biceps tendon. Pain may only be felt with use of your arm in front of your body or you may also have audible clicking and popping in your shoulder.

Treatment options

Non-surgical

Diagnosed via a MRI-Arthrogram is required to demonstrate the S.L.A.P. lesion.

Surgical

Performed via key-hole minimally invasive surgery where the tear is re-anchored to its normal position.

Condition

The sternoclavicular joint is located towards the center of your chest and is the point at which the clavicle (collarbone) and sternum (breastbone) meet.

What happens

If the disc or ligaments providing soft tissue pad cushioning between the collarbone and breastbone develops a tear (through injury or wear and tear), it can be very painful. A patient with a tear may feel pain and stiffness at the joint, as well as having clicking and popping from the torn ligaments.

Treatment options

Non-surgical

Treatment with rest, ice, and anti-inflammatory medication. For persistent, recurrent subluxation, reduction can be achieved.

Surgical

Surgical treatment involves reduction and reconstruction of the ligaments.

Condition

This is a condition due to irritation and compression to the Suprascapular nerve.This is the main nerve which provides feeling to the shoulder joint. It can result in pain, weakness, or both.

What happens

Typically it is a chronic condition which is relatively rare, and so it is commonly not diagnosed until other more common causes of shoulder pain have been considered.

Treatment options

Non-surgical

Anesthetizing (numbing) the SSN with an injection can relieve shoulder pain in many conditions. Stretching and anti-inflammatory medications may also form part of treatment.

Surgical

Involving decompression of the nerve, either through open shoulder or arthroscopic surgery.

Condition

The subscapularis, located in the front of the shoulder, is the most powerful of the rotator cuff muscles. Its function is to help the shoulder joint move and create powerful motions (e.g. a tennis stroke or in swimming).

What happens

Subscapularis tendon injuries usually occur as the result of a traumatic event, such as a fall, and usually affect individuals who are younger than those who typically present with a supraspinatus tendon tear.

Treatment options

Surgical

If the tendon is torn, it can be fixed surgically using arthroscopic or open techniques. Surgery is followed by supervised therapy involving passive and active stretching.

Want more detail?

Make a time now to meet with Dr Dan at one of his clinics.

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